Provider Demographics
NPI:1508268384
Name:PEGUS-NEPTUNE, PERTHRINA
Entity Type:Individual
Prefix:
First Name:PERTHRINA
Middle Name:
Last Name:PEGUS-NEPTUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 GRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2866
Mailing Address - Country:US
Mailing Address - Phone:917-647-0642
Mailing Address - Fax:718-782-6690
Practice Address - Street 1:157 GRAHAM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2866
Practice Address - Country:US
Practice Address - Phone:917-647-0642
Practice Address - Fax:718-782-6690
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker